Observation of limbal-stem-cell transplantation to treat pterygium combined with conjunctivochalasis

Abstract:

AIM: To observe the efficacy, complications and ocular surface tear dynamics of the treatment for pterygium combined with conjunctivochalasis by inferior limbal-stem-cell transplantation.

METHODS: All 30 patients(46 eyes)diagnosed as pterygium combined with conjunctivochalasis in our hospital from December, 2010 to December, 2012 with a mean age of 61.2y(SD 7.2, range 49-75)were subjected to observation. After excision of nasal pterygium, an equivalent size of conjunctival flap linked with corneal limbal stem cell from inferior limbus was transplanted to the exposed sclera. Afterwards, the inferior bulbar conjunctiva was trimmed and fixed onto surface of sclera and inferior corneal limbus. After one-year follow-up, the comparisons regarding vision acuity between pre-operation and post-operation(1mo later)as well as ocular-surface tear dynamics changes including several indexes like altitude and integrity of tear meniscus, break-up time(BUT), corneal fluorescein staining and chloramphenicol gestation test before and 3mo after surgery were made. The operative complications and the recurrence rates 1y after operations were recorded.

RESULTS: Median visual acuity was 0.2(0.04-0.6)before the operation and median visual acuity was 0.4(0.04-1.0)1mo after the operation. Of total 46 eyes in 21 eyes(45.7%), visual acuity improved. No vision changes were found in other 25 eyes(54.3%). Significant difference(P<0.01)of vision acuity before and after surgery was found. In addition, break-up time(BUT), corneal fluorescein staining and chloramphenicol gestation test and altitude and integrity of tear meniscus show better results 3mo after surgery than that of pre-operation, which showed statistically significant(P<0.05). After 1y follow-up, 33 eyes(71.7%)healed while problems in 11 eyes(23%)were relieved. The total efficacy rate was 95.6%. Nonetheless, invalid surgeries were noticed in two eyes(4.4%)that affected by recurrence of pterygium. The 33 eyes(71.7%)affected by conjunctivochalasis was cured in terms of subjective evaluation and improved in 9 eyes(19.6%), but 4 eyes(8.7%)exhibited no evident improvement in terms of subjective complains. Total efficacy was 91.3%. The 41 eyes(89.1%)were reported to be normal while 5 eyes(10.9%)were revealed to be abnormal in terms of objective therapeutic evaluation. And this condition was so-call conjunctivochalasis recurrence with a recurrence rate of 10.9%. No proliferation of granulation, narrowing inferior fornix and malfunction of eye movements was found.

CONCLUSION: Inferior-limbal-stem-cell transplantation to treat pterygium combined with conjunctivochalasis obtains better results. It proves to eradicate or relieve symptoms of patients effectively and ameliorate ocular-surface tear dynamics.

Key words:corneal limbal stem cell; pterygium; conjunctivochalasis; tear dynamics; surgery